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Feature Articles - The Repression of War Experience by W. H. Rivers

Fitness for Military Service

Before I conclude a few words
must be said about an aspect of my subject to which I have not so far referred. When treating officers or men suffering from war neurosis we have not only to
think of the restoration of the patient to health; we have also to consider the
question of fitness for military service. It is necessary to consider
briefly the relation of the prescription of repression to this aspect of
military medical practice.

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When I find that a soldier is
definitely practising repression I am accustomed to ask him what he thinks is
likely to happen if one who had sedulously kept his mind from all thoughts of
war, or from special memories of warfare, should be confronted with the reality,
or even with such continual reminders of its existence as must inevitably
accompany any form of military service at home.

If, as often happens in the
case of officers, the patient is keenly anxious to remain in the Army, the
question at once brings home to him the futility of the course of action he has
been pursuing. The deliberate and systematic repression of all thoughts
and memories of war by a soldier can have but one result when he is again faced
by the realities of warfare.

Several of the officers I have
described or mentioned in this paper were able to return to some form of
military duty, with a degree of success very unlikely if they had persisted in
the process of repression.

In other cases, either because
the repression had been so long continued or for other reason, return to
military duty was deemed inexpedient. Except in one of these cases no
other result could have been expected with any form of treatment.

The exception to which I refer
is that of the patient who had the sudden attacks of reasonless depression.
This officer had a healthy appearance and would have made light of his
disabilities at a medical board. He would certainly have been returned to
duty and sent to France.

The result of my line of
treatment was to produce a state of anxiety which led to his leaving the Army.
This result, regrettable though it be, is far better than that which would have
followed his return to active service, for he would inevitably have broken down
under the first stress of warfare, and might have produced some disaster by
failure in a critical situation or lowered the morale of his unit by committing
suicide.